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This article was originally submitted to the Christmas BMJ and rejected as it wasn’t ‘interesting enough’. I’d forgotten I’d ever written it but reminded by the following tweet here is the original paper – please take it in the spirit in which it was originally intended!

Will the World Cup impact on the number of pts attending Emergency Departments? @NHSEngland @NHSChangeday @Damian_Roland @DrBruceKeogh

— Jamie Crew (@jamiemcrew) June 12, 2014

The idea for the paper came from Ejiro Obakponovwe, who sadly passed away recently having developed ovarian cancer, I am sure she would have been delighted to see the paper released and if you do enjoy it please consider making a donation to a Joyful Joy – a charity she supported.

Presentations to Emergency Departments during a Major Football Championship:

Win, lose or draw – Does it matter if England can’t score?

Abstract:

Hypothesis: Anecdote suggests major sporting events reduce attendance at Emergency Departments. The poor performance of the English national side at this summer’s World Cup raised concerns that this was not occurring when England failed to win.

Objectives: To determine whether England match results during major football championships affect attendance at Emergency Departments

Design: A retrospective descriptive study

Setting: A busy city centre based Emergency Department

Data Sources: Attendances to the Resuscitation, Major, Minor and Paediatric areas were counted for the 8 hour period surrounding kick off time (4 hours either side) of World Cup and European Championship matches England played in events since 2004. These were matched against equivalent days in non-championship years.

Results: On average, the number of attendances to the Emergency Department around kick off on match days was 160 compared to 200 (Ratio 1.25, 95% CI 1.12 to 1.40). This reduction held true when the whole 24 hour period was considered (p=0.035). The trend was observed for categories of Minor (Ratio 1.51 (95% CI 1.28 to 1.77), p<0.0001) and Paediatric (Ratio 1.22 (95% CI 1.04 to 1.43), p=0.015) attendances but not Major (Ratio 0.96 (95% CI 0.82 to 1.12), p=0.578) or Resuscitation (Ratio 1.12 (95% CI 0.76 to 1.66), p=0.570). There was no evidence to suggest a difference in the number of total attendances between matches where England won or lost/drew (p=0.148).

Conclusions: The results indicate that staff in Emergency Departments should not have been concerned about England’s poor performance this summer as it did not increase their workload. Given an overall reduction in attendances the NHS should have an active interest in the England football squad and its management structure to ensure continued presence at World Cups and European Championships.

What is already known on this topic?

Although anecdote strongly supports the theory attendances to Emergency Departments decrease during major sporting events there is evidence to refute this.

Little research has examined the effect on the actual result of the English football team on attendances to Emergency Departments.

What this study adds?

A poor England performance does not appear to affect attendance although the public reduce their Minor or Paediatric attendances during championship matches in which England are playing. However they recognise that serious illness needs treating as demonstrated by the fact Major and Resuscitation area attendances are unaffected.

This may indicate the NHS should be interested in the future fortunes of the England team.

Introduction

Anecdote in Emergency Departments (EDs) often concerns a reduction of attendances when large sporting events are taking place. There is evidence to suggest this is not the case ^1,2 and persons presenting with alleged physical assault to EDs may actually increase ³. The staff at the Leicester Royal Infirmary Emergency Department felt negative England performances were affecting attendances during this year’s disappointing World Cup campaign. Previous research in this area has only investigated presentations with alleged assaults when a national team played ⁴with increases following victories. We postulated that following an England loss attendances for minor injuries may increase in the hours following the game compared to matches in which England won (in the latter case the supporters’ physical pain is compensated by the enjoyment of celebrating).

Methods

The Leicester Royal Infirmary Emergency Department Information System (EDIS) was interrogated for attendance figures from 2004-2010. We extracted attendance data for each England match day (Table One) of the European Championships (Portugal 2004) and the World Cup (Germany 2006, South Africa 2010). Unfortunately England did not qualify for the 2008 European Championships. Attendances were categorised into Resuscitation, Major, Minor and Paediatric Group with the age and time of presentation also noted. Non-match days were identified for comparatives on the same day of the week in the following year (or a year earlier for 2010). Attendances, for the purpose of this study, were counted for the 8 hour period surrounding kick off time (4 hours either side).

Poisson regression models, correcting for over dispersion, in SAS version 9.1.3 were used to compare the number of attendances between the 13 match days and the equivalent non-match days, both overall and by categories of Major, Minor, Child and Resuscitation. Poisson regression models also compared the number of attendances in ED on match days between matches where England won to matches where England drew or lost. No identifiable data was requested from the database.

Results

Attendance data is demonstrated in Figures One and Two. There were a lower number of attendances in the 8 hour period surrounding match days compared to non-match days (p<0.0001). On average, this was 160 on match days compared to 200 on non-match days (Ratio 1.25, 95% CI 1.12 to 1.40). This trend was observed for categories of Minor and Paediatric attendances but not Major or Resuscitation (Table two). Using a matched pairs t test, there was also a lower average number of attendees in the 24 hours period of a match days compared to non-match days (p=0.035).

There was no evidence to suggest a difference in the number of total attendances between matches where England won or lost/drew (p=0.148). This trend was observed for all categories (Table Three).

Conclusion

Although there were only 13 available matches (England’s failure to qualify for the 2008 European championship reducing our dataset) it appears actual results impact little on attendance figures. Therefore staff not on shifts during match days should not feel too guilty about watching the match as the result is unlikely to be relevant to the department’s workload. In fact, as our results support the anecdote that attendances decrease, they may feel even less guilty. The general public appear to be able to tolerate the discomfort of a minor illness or injury on match days but perhaps do not feel strongly enough about England’s chances when faced with a more major complaint. The overall reduction in attendances indicates EDs, and perhaps the NHS, should strongly support the English Football Association’s attempts to secure England a strong manager into the next decade as this may well affect attendances and subsequently costs. This would be especially true if England do win the rights to host the 2018 event.

 

Many thanks to Suzanne Rafelt (Medical Statistician) and Patrick Walsh (Medical Student) at the University of Leicester for their initial help with the article.

Please consider making a donation to a Joyful Joy – a charity Ejiro supported.